Normal Microbial Flora- denotes the population of microorganisms that inhabit the skin and mucous

membranes of healthy normal persons. The microorganisms that live inside and on humans (now
referred to as the normal microbiota) are estimated to outnumber human somatic and germ cells by
a factor of 10.

 The genomes of these microbial symbionts are collectively defined as the microbiome.
 Normal microbiota provides a first line of defense against microbial pathogens, assist in
digestion, play a role in toxin degradation, and contribute to maturation of the immune
system.
 Shifts in the normal microbiota or stimulation of inflammation by these commensals may
cause diseases such as bacterial vaginosis, periodontitis, and inflammatory bowel disease

The skin and mucous membranes always harbor a variety of microorganisms that can be arranged
into two groups: (1) the resident microbiota consists of relatively fixed types of microorganisms
regularly found in a given area at a given age; if disturbed, it promptly reestablishes itself; and (2)
the transient microbiota consists of nonpathogenic or potentially pathogenic microorganisms that
inhabit the skin or mucous membranes for hours, days, or weeks.

 The transient microbiota is derived from the environment, does not produce disease, and
does not establish itself permanently on the surface. Members of the transient microbiota
are generally of little significance so long as the normal resident flora remains intact.
However, if the resident microbiota is disturbed, transient microorganisms may colonize,
proliferate, and produce disease.
Table 1. Bacteria commonly found on the surfaces of the human body.
Con- Ant.
Lower
BACTERIUM Skin junc- Nose Pharynx Mouth ure- Vagina
GI
tiva thra
Staphylococcus epidermidis (1) ++ + ++ ++ ++ + ++ ++
Staphylococcus aureus* (2) + +/- + + + ++ +/- +
Streptococcus mitis + ++ +/- + +

Streptococcus salivarius ++ ++

Streptococcus mutans* (3) + ++

Enterococcus faecalis* (4) +/- + ++ + +

Streptococcus pneumoniae* (5) +/- +/- + + +/-

Streptococcus pyogenes* (6) +/- +/- + + +/- +/-

Neisseria sp. (7) + + ++ + + +

Neisseria meningitidis* (8) + ++ + +

Pseudomonas aeruginosa* (10) +/- +/- + +/-

Haemophilus influenzae* (11) +/- + + +

Bacteroides sp.* ++ + +/-

Bifidobacterium bifidum (12) ++

Lactobacillus sp. (13) + ++ ++ ++

Clostridium sp.* (14) +/- ++

Clostridium tetani (15) +/-

Actinomycetes + +

Spirochetes + ++ ++

Mycoplasmas + + + +/- +

++ = nearly 100 percent + = common (about 25 percent) +/- = rare (less than 5%) *=
potential pathogen

(1) The staphylococci and corynebacteria occur at every site listed. Staphylococcus epidermidis is
highly adapted to the diverse environments of its human host. S. aureus is a potential pathogen. It is
a leading cause of bacterial disease in humans. It can be transmitted from the nasal membranes of
an asymptomatic carrier to a susceptible host.

S. epidermidis. Scanning EM. CDC.

(2) Many of the normal flora are either pathogens or opportunistic pathogens, The asterisks indicate
members of the normal flora a that may be considered major pathogens of humans.

S. aureus. Gram stain.

(3) Streptococcus mutans is the primary bacterium involved in plaque formation and initiation of
dental caries. Viewed as an opportunistic infection, dental disease is one of the most prevalent and
costly infectious diseases in the United States.

Streptococcus mutans. Gram stain. CDC

(4) Enterococcus faecalis was formerly classified as Streptococcus faecalis.The bacterium is such a
regular a component of the intestinal flora, that many European countries use it as the standard
indicator of fecal pollution, in the same way we use E. coli in the U.S. In recent years, Enterococcus
faecalis has emerged as a significant, antibiotic-resistant, nosocomial pathogen.
Vancomycin Resistant Enterococcus faecalis. Scanning E.M. CDC

(5) Streptococcus pneumoniae is present in the upper respiratory tract of about half the population.
If it invades the lower respiratory tract it can cause pneumonia. Streptococcus pneumoniae causes
95 percent of all bacterial pneumonia.

Streptococcus pneumoniae. Direct fluorescent antibody stain. CDC.

(6) Streptococcus pyogenes refers to the Group A, Beta-hemolytic streptococci. Streptococci cause
tonsillitis (strep throat), pneumonia, endocarditis. Some streptococcal diseases can lead to
rheumatic fever or nephritis which can damage the heart and kidney.

Streptococcus pyogenes. Gram stain.

(7) Neisseria and other Gram-negative cocci are frequent inhabitants of the upper respiratory tract,
mainly the pharynx. Neisseria meningitidis, an important cause of bacterial meningitis, can colonize
as well, until the host can develop active immunity against the pathogen.

Neisseria meningitidis. Gram stain.

(8) While E. coli is a consistent resident of the small intestine, many other enteric bacteria may
reside here as well, including Klebsiella, Enterobacter and Citrobacter. Some strains of E. coli are
pathogens that cause intestinal infections, urinary tract infections and neonatal meningitis.
E. coli. Scanning E.M. Shirley Owens. Center for Electron Optics. Michigan State University.

(9) Pseudomonas aeruginosa is the quintessential opportunistic pathogen of humans that can invade
virtually any tissue. It is a leading cause of hospital-acquired (nosocomial) Gram-negative infections,
but its source is often exogenous (from outside the host).

Colonies of Pseudomonas aeruginosa growing on an agar plate. The most virulent Pseudomonas
species produce mucoid colonies and green pigments such as this isolate.

(10) Haemophilus influenzae is a frequent secondary invader to viral influenza, and was named
accordingly. The bacterium was the leading cause of meningitis in infants and children until the
recent development of the Hflu type B vaccine.

Haemophilus influenzae. Gram stain.

(11) The greatest number of bacteria are found in the lower intestinal tract, specifically the colon
and the most prevalent bacteria are the Bacteroides, a group of Gram-negative, anaerobic, non-
sporeforming bacteria. They have been implicated in the initiation colitis and colon cancer.

Bacteroides fragilis. Gram stain.

(12) Bifidobacteria are Gram-positive, non-sporeforming, lactic acid bacteria. They have been
described as "friendly" bacteria in the intestine of humans. Bifidobacterium bifidum is the
predominant bacterial species in the intestine of breast-fed infants, where it presumably prevents
colonization by potential pathogens. These bacteria are sometimes used in the manufacture of
yogurts and are frequently incorporated into probiotics.

Bifidobacterium bifidum. Gram stain

(13) Lactobacilli in the oral cavity probably contribute to acid formation that leads to dental
caries. Lactobacillus acidophilus colonizes the vaginal epithelium during child-bearing years and
establishes the low pH that inhibits the growth of pathogens.

Lactobacillus species and a vaginal squaemous epithelial cell. CDC

(14) There are numerous species of Clostridium that colonize the bowel. Clostridium perfringens is
commonly isolated from feces. Clostridium difficilemay colonize the bowel and cause "antibiotic-
induced diarrhea" or pseudomembranous colitis.

Clostridium perfringens. Gram stain.

(15) Clostridium tetani is included in the table as an example of a bacterium that is "transiently
associated" with humans as a component of the normal flora. The bacterium can be isolated from
feces in 0 - 25 percent of the population. The endospores are probably ingested with food and
water, and the bacterium does not colonize the intestine.

Clostridium tetani. Gram stain.

(16) The corynebacteria, and certain related propionic acid bacteria, are consistent skin flora. Some
have been implicated as a cause of acne. Corynebacterium diphtheriae, the agent of diphtheria, was
considered a member of the normal flora before the widespread use of the diphtheria toxoid, which
is used to immunize against the disease.
Corynebacterium diphtheriae. No longer a part of the normal flora.